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Motor Speech Exam 3 > Ch 17 > Flashcards

Ch 17 Flashcards

1
Q

what is a way to test respiration?

A

have the pt. maintain a stream of bubbles for 5 seconds in a glass of water with the straw at 5 cm. if they can’t, then practice non-speech respiratory tasks. (idea is to produce sufficient sub glottal air pressure)

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2
Q

Some other methods that involve speech include?

A
  • practicing max vowel prolongation with the clinician giving feedback to duration and loudness,
  • recorder with a VU meter or visipitch (wait for 5 seconds of steady, strong vowel prolongation and being able to produce several syllables on one exhalation
  • pushing, pulling, bearing down during speech and non-speech tasks (increases respiratory drive for speech and controlled exhalation tasks-steady stream exhaled slowly)
  • inspiratory and expiratory strength training may be helpful
  • instrumentation is used
  • postural adjustments may need to be made to maximize respiratory support
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3
Q

What are some prosthetics for respiration?

A
  1. abdominal binders and corsets can help posture and weak abdominal muscles (don’t use with ALS who have trouble with inspiration, need medical approval because it could restrict breathing and lead to pneumonia)
  2. Expiratory Board/Paddle: mounted on wheelchair and put in position to lean into, may help face air out in exhalation
  3. May push in on abdomen with hands in exhalation
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4
Q

Behavioral Compensation for Respiration:

A
  1. )practice inhaling more deeply
  2. )exhaling more forceful
  3. )work on controlling breath(not letting all air out on one breath-letting air out slowly)
  4. ) shorter phrases per breath group
  5. )correct maladaptive breath groups -pt may only be producing one word per breath when they have sufficient support for more words
  6. use biofeedback machines with visual feedback.
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5
Q

What are some med treatments for phonation?

A
  1. )Laryngeal Surgery
    - implants for paralyzed vocal fold
    - arytenoid adduction (repositions paralyzed fold)
    - Recurrent nerve dissection (used for SD and prevents hyper adduction and spasms
    - laryngeal adductor denervation reeinervation- denervated by certain branches reinervated

2.) Injections for VF Paralysis- injections of substances, fat and collagen, into paralyzed VF aid in VF approximation

3.) Toxin Injection
-botox injections into thyroarytenoid muscle for adductor SD and tremor. (Botox blocks the release of ACH in Thyroarytenoid muscles.
(botox lasts 3-4 months- side effects such as breathiness and mild dysphagia)

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6
Q

Prosthetic Mx for phonation:

A
  • Vocal Intensity controller (gives feedback about too much or too little loudness with visual feedback (VU Meter)
  • Amplification System-portable voice amplifier,
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7
Q

Phonation-Behavioral Mx:

A
  • effort closure strategies such as push/pull/lift techniques, coughing in controlled manner. These maximize VF Adduction and may help strengthen folds.
  • May be helpful for some its to learn to start phonation at beginning of exhalation so as not to waste air
  • LSVT for PK’s pts.
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8
Q

How to test resonance?

A

have pt hold nose and speak to see impact of velopharyngeal inadequacy. If speech improves, focusin on V-P function is indicated.

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9
Q

surgical mx for resonance?

A
  • pharyngeal flap

- injection of some substance into posterior pharyngeal wall to improve VP closure

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10
Q

Prosthetic mx for resonance:

A

palatal lift prosthesis
(need dental support)
-wearing a nose clip sometimes helps

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11
Q

Behavioral mx for resonance:

A
  • slowing rate and over articulating, (such as opening mouth more, exaggerated jaw movement, and being more precise) may help hypernasality
  • resistance training during speech (using a CPAP-gives airflow into nasal cavities)
  • visual feedback using mirror (SEE Scape)
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12
Q

Articulation surgical mx:

A
  • neural anastomosis- (surgical connection between 2 nerves) used for cosmetic functions such as smiling- doesn’t usually improve speech. 12th nerve is connected to 7th nerve…
  • botox for spasmodic torticollis, lingual dystonias-
  • prosthetic mx- a bite block is sometimes used to help jaw control… its made of putty or similar material…
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13
Q

What are some articulation (behavioral mx) strength training exercises:

A

oral motor exercises- push tongue against tongue blade
-(controversial)
-it is contraindicated with MG and ALS
-not necessary for may pts. -tongue and lips use only 10% -30% of their max force in speech and jaw just 2%
-exercises done in 5 sets, of 10 reps, 3-5 times a day.
(fewer don’t do much good)

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14
Q

Articulation stretching

A
  • steady, continuous, prolonged…
  • spasticity and rigidity
  • slow movements of articulators beyond their typical ROM…
  • Exaggerating consonants may improve imprecision
  • compensatory strategies (tongue blade instead of tongue tip)
  • biofeedback
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15
Q

What is a traditional artic approach?

A
  • phonetic placement (visual, physical, and verbal)
  • integral stimulation(watches and listens to tasks-
  • phonetic derivation( use non-speech gestures to establish targets -blowing to indicate /u/
  • minimal pairs (may/pay, bye/pie, ) help pt understand contrasts between phonemes)
  • intelligibility drills-listener naive to the task and tells the speaker what was heard…
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16
Q

what is the most important behavioral change to improve intelligibility? Usually involves rate reduction

A

Rate

17
Q

Prosthetic management for rate?

A
  1. ) DAF -delayed auditory feedback slows rate

2. ) pacing board: slows rate down…

18
Q

Non prosthetic Rate mx:

A
  1. )hand/finger tapping in time syllable production: if PK’s pts. note that they may accelerate their hand tapping along with speech and ataxic pts. may have irregular hand tapping also…
  2. ) visual feedback: from oscilloscope to pace rate… tell pt to speak at a rate that would fill the screen-slows rate
  3. ) Rhythmic Cueing: Clinician points to word in rhythmic fashion…
19
Q

Prosody and naturalness mx:

A
  • work on breath groups…chunking utterances into natural syntactic units
  • contrastive stress drills-helps to reduce monotone (in response to questions, does John HATE Mary, John LOVES Mary)
  • LSVT highs and lows work on pitch changing…
20
Q

tx for flaccid

A

work on increasing strength unless LMN innervation is completely lacking…

  • with prog. dx (maintain function)
  • pushing/pulling for reps. weakness
  • adductor vf weakness? surgical, injection, or effortful closure tx..
  • for resonance? palatal lift or pharyngeal flap surgery(nares occlusion of vp strengthening exercises)
  • MG pts. (managed with meds but also counseling about limiting length of time they speak can be done)
21
Q

Spastic

A

don’t do pulling, pushing, or effortful closure techniques (hyper adduction is already a problem)

  • some meds may help decrease spasticity (effect on speech is uncertain)
  • relaxation exercises may help
  • pseudo bulbar effect? meds may help
  • behavior mod for pseudo bulbar effect (head turning)
22
Q

ataxic

A
  • strength exercises and surgical/prosthetic tx no needed….
  • focus of mx is behavioral-improving incoordination and intelligibility through modifying rate and prosody…
23
Q

Hypokinetic

A

LSVT Loud (respiratory and phonatory effort)
-“speak loud”
-surgical tx: pallidotomy, thalamotomy, lesions are placed in globus pallidus or thalamus to reduce tremors (DBS)
-pharm tx: l-dopa (may improve speech but not always)
-behavioral mx: work on rate control and over articulation
-

24
Q

Hyperkinetic:

A

-mainly surgical and pharmacologic to control abnormal movements. SLP can teach compensatory strategies (holding pipe in mouth)
-DBS- may be used to reduce tremors
-

25
Q

UUMN

A
  • medical or prosthetic ex’s not needed due to mild, transient nature,
  • may work on specific articulation, rate, and prosody problems…or on tongue strengthening…
26
Q

Mixed

A

use tx’s appropriate for individual’s dysarthria

27
Q

Comm Oriented Tx:

-Speaker Strategies?

A

prepare listener with alert signals

  • tell listener how comm. will happen
  • identify topic
  • increasing redundancy may help
  • others may need to simplify content and length.(simple predictable sentences)
  • use gestures-
  • monitor listener comprehension
  • use alphabet board
28
Q

listener strategies:

A
  • keep eye contact
  • work at comprehending
  • modify environment (reduce noise, improve lighting)
  • maximize listener hearing and visual acuity
29
Q

Interaction strategies

A

don’t comm. important things when fatigue or stress is a factor

  • select conducive speaking environment( min noise and distraction)
  • maintain eye contact b/t speaker and listener
  • identify breakdown and estb means of feedback (listenr repeats words of speaker)
  • repair strategies- rephrase, use synonyms, steel prob words, identify salient words,
  • est what works best when ((

Motor Speech Exam 3 (6 decks)

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